| NPI | 1962423129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY IRENE FETTIG Business Manager 360-892-7107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00008735) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-22 |